The Big Change

Menopause marks a critical milestone for women. It can be a challenging time, but there are ways to deal with its uncomfortable symtoms.

As women approach menopause, some look forward to being freed from the monthly menstruation, but some have trepidations about potential menopausal problems.

SIGNS & SYMPTOMS

Menopause usually occurs between 45 and 55 years of age, and is said to have occurred when menstruation has ceased for 12 months. However, the hormonal fluctuations start up to 10 years before menopause; therefore, symptoms may present in the peri-menopausal period. As hormone levels decrease, symptoms of menopause may emerge, although their presentation and severity varies greatly between individuals. The most common symptoms of menopause are hot flushes, insomnia, vaginal dryness, irritability, mood swings and depression. Many symptoms resolve with simple dietary and lifestyle changes, the addition of a daily supplement or local therapy, while some may require hormonal therapy.

Those suffering from hot flushes should avoid hot beverages, try to sleep in a cooler environment and use layered bedding that can be easily removed when necessary. Good sleep habits are important for all but essential for those who have trouble falling asleep. They should go to bed and wakeup at consistent times; relaxand wind down before sleep by reading or listening to music; and avoid caffeine and alcohol late in the day. Those whose symptoms persist in spite of these measures can use supplements like red clover isoflavone.

The most common symptoms of menopause are hot flushes, insomnia, vaginal dryness, irritability, mood swings and depression.

For more severe cases, hormonal therapy may benecessary to provide relief. Increased irritability, anxiety, fatigue and depression arecommon complaints. Some may be due to the fluctuation in hormone levels, but many other factors like family and work issues, as well as deteriorating health, may contribute to or aggravate these problems. Relaxation and stress reduction techniques such as deep-breathing exercises and massage, adopting a healthy lifestyle (good nutrition, daily exercise) and taking time out for yourself (enjoying a self nurturing activity) may help. Discussing mood issues with your doctor can help identify thecause and assess the severity of depression, and decide on the most appropriate treatment.

HORMONAL THERAPY

Vaginal dryness may start even in the early 40s, and may cause pain during sexual intercourse and urinary symptoms like frequency and urgency.

Vaginal lubricants may decrease friction and reduce discomfort during intercourse. Those with significant vaginal atrophy and urinary symptoms may benefit from vaginal oestrogen pessary or cream treatment.

There are, however, many women with moderate to severe menopausal symptoms for whom these non-hormonal lifestyle changes provide little relief, and they will benefit from hormonal therapy (HT). The Women’s Health Initiative (WHI) results 10 years ago scared many women away from using HT altogether. We have since learnt a lot about the risks and benefits of HT.

Experts agree that, for most women, HT is okay to control moderate to severe menopausal symptoms such as hot flushes and vaginal dryness, within 10 years of menopause and up to age 59. Women should be given the lowest dose for the shortest amount of time needed to keep the symptoms under control. Individualisation is key in the decision to use hormonal therapy. Therefore, discussion between the woman and her doctor is crucial, with consideration given to the woman’s quality of life as well as personal risk factors such as age, time since menopause, and risk of blood clots, heart attack, stroke and breast cancer.

STAY POSITIVE

The attitude with which you embark upon this transition can have a tremendous impact on your experience. Studies show that negative beliefs held prior to menopause tend to lead to a more difficult experience. Therefore, women should approach the change positively, empowered by the knowledge that there are many means of relieving symptoms should they occur. To borrow a quote from Kim Cattrall, who starred as Samantha in the comedy series Sex and the City, “I see menopause as the start of the next fabulous phase of life as a woman. Now is a time to ‘tune in’ to our bodies and embrace this new chapter. If anything, I feel more myself and love my body more now, at 58 years old, than ever before.”

EAST-WEST COLLABORATION

A graduate of the National University of Singapore, Dr Chen Chern Yi obtained the Post-Graduate Diploma in Acupuncture in 2011 and is on the Singapore Registry of Acupuncturists. Besides acupuncture, she believes in other modalities in traditional Chinese medicine (TCM), such as herbs, and is aware that some products are absolutely contraindicated when it comes to issues related to obstetrics and gynaecology.

She is a member of the Royal College of Obstetricians & Gynaecologists (UK) and a Fellow of the Academy of Medicine, Singapore. She is also a member of the College of Obstetricians & Gynaecologists (Singapore), the Society for Colposcopy and Cervical Pathology of Singapore, and the Obstetrical & Gynaecological Society of Singapore.

Dr Chen has been in private practice since 2002 after training and working at the KK Women’s and Children’s Hospital.

Women should approach the change positively, empowered by the knowledge that there are many means of relieving symptoms should they occur.